Exploring Assistive Technology (AT)
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Carenfa18GS420-withnotes.pptAdministration, Rehabilitation, & Postsecondary Education (ARPE)
(in College of Education)
- Doctorate of Education, Educational Leadership (Community College Leadership)
- Master of Arts in Educational Leadership
- Focus in Community College Teaching & Leadership
- Specialization in Student Affairs
- Master of Science in Rehabilitation Counseling
Interwork Institute http://www.interwork.sdsu.edu
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I serve as the Chair of our Department – ARPE – and we offer the following degrees, plus we coordinate the Leadership Minor in collaboration with the Division of Student Affairs. You can find out more about our programs on the Interwork website.
Interwork Institute:
Created 25+ years ago to join like-minded educators in collaborative efforts that would benefit individuals with disabilities and other non-traditional, underserved, & underrepresented learners
Established as an Institute of SDSU, created by the Department of Administration, Rehabilitation, & Postsecondary Education (in the College of Education)
Partners with SDSU Research Foundation for administration of external funding
Interwork is the umbrella/infrastructure for administering grants and contracts (i.e., funding that comes from outside of the University) – we administer about $10 million worth of funding that support a variety of projects, including research, training, and leadership development. Many of our grants enable us to hire students to work with us. Again, you can learn more details on the Interwork site.
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Specializations/Certificates in Rehabilitation Counseling
- Rehabilitation (Assistive) Technology (with College of Engineering)
- Psychiatric Rehabilitation/LPCC
- Cognitive Disabilities
- Supported Employment & Transition
- Rehabilitation Administration
These are areas that students can develop specialized skills in working with individuals with a variety of disabilities. Each of these certificate programs can be embedded in the 60-unit Master of Science degree in Rehabilitation Counseling.
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Vocational Rehabilitation
- VR is all about jobs!
- It’s the state and federal system of agencies that helps individuals with significant disabilities figure out their career paths, find and maintain employment – 80 agencies across US & territories; about $2.5-3 billion
- CA-DOR (in HHS Agency) serves over 120,000 consumers annually via 13 districts across CA http://www.rehab.cahwnet.gov/
Although VR has been around for a long time, many people don’t know about it, at least until they need it. All state departments of rehabilitation provide support to individuals with disabilities to find and keep employment. For example, if someone gets injured on their job, they may go to VR to help retrain for another job or to get support (like using assistive technology) to keep their same job. VR can help people whether they were born with a disability or if they acquired it through accidents, illnesses, or other trauma. Many students with disabilities can qualify for funding from VR to go to college to prepare for employment.
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Rehabilitation Counselors
- Provide counseling, assessment, career development to individuals with disabilities
- Partner with people to make informed choices, build viable careers, & live more independently in the community
- Can work in a variety of rehab settings: federal, state, local agencies; postsecondary education; Veterans Administration; private rehabilitation
- Intersection with Student Services/Student Affairs in community colleges & higher education
We train students in our program in these areas – they have many options for employment. If you’re interested in learning more about this career path, we will be holding an open house information night, which can be attended in person or via distance technologies. Please check the Interwork website for specific dates, times, and access.
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What is Assistive Technology?
Write down 5 examples.
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What do you know about A.T.? Can you think of examples?
Consider:
Richard, born without arms or legs in 1969, has learned how to live his life with a great deal of independence. He has control over many activities in a variety of environments, including work, transportation, recreation/exercise, and daily activities.
What types of assistive technology might be helpful for him to access:
Daily living (showering, brushing teeth, eating, shaving, dressing)?
Transportation (at home, in community)?
Recreation/exercise?
Using a computer?
We’ll come back to Richard’s story later…..be thinking about these areas as you learn more about A.T. throughout the presentation, which includes many examples.
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Advances in technology in general and assistive technology for individuals with disabilities open opportunities previously thought of as impossible!
Advances in technology in general and assistive technology for individuals with disabilities open opportunities previously thought of as impossible!
Photo shows Lucas, a young man who uses a wheelchair due to having cerebral palsy. He is rappelling off the side of a building as part of a fundraiser – he enlisted people to pledge funds that went to a non-profit organization that supports children with disabilities to participate in after school activities with their friends and neighbors.
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- Limited choices and options for AT
- Medical professionals primarily prescribed AT
- View of disability was considered as a health problem that required treatment and cure
- About 27,000 AT products available
- Scherer, 2014
Our access to assistive technology was limited in the 20th century. An editorial in an international journal, Disability & Rehabilitation by Dr. Marcia Scherer, described some thoughts on the changing perspectives about Assistive Technology services. She talked about the focus being on people and their needs as a whole population – for example, all those who were blind or had physical disabilities. Individuals within these populations weren’t the focus of attention, and products or devices were not designed to fit individual needs or preferences. Overall, AT devices were considered in more general terms, that is, the options and choices in wheelchairs and other equipment were quite limited. Therefore, services for people with disabilities and chronic health conditions came under the purview of medical professionals who, in keeping with their training, viewed disability as a health problem which required treatment and cure. In early 2000, about 27,000 AT products were available for purchase.
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the condition of the individual with the disability is the problem; that is, their failure to perform major life activities.
~ Daniels, 1990
In other words,
The medical model, also referred to as the “individual defect paradigm” seeks outcomes such as improved functional capacity, return to work, and less use of support services, all positive outcomes. However, at the same time, the individual with the disability was rarely part of the process and the primary authority was the professional.
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- Service infrastructure has been built
- Protection of health, safety, & rights via legislation and policies
- Focus on eliminating, minimizing barriers in environment
- About 40,000 AT products available
- Scherer, 2014
In the 21st century, we have built a service infrastructure and have legislation and policies in place to protect our health, safety, and rights, allowing us to focus more on the individual person and their needs. We have changed our focus from people with disabilities as being deficient and of lesser status who require treatment and segregation, to focusing on how barriers in the environment are the problem and can be eliminated or minimized. We can modify and customize AT products to meet varied needs and preferences of individuals. By this time in 2014, there were at least 40,000 AT products available.
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Technology/ecology paradigm:
- Source of the problem is the lack of fit between a person’s goals, capabilities, & environmental resources
- Lack of access to appropriate resources; i.e., tools, information, training
- Outcomes: equal opportunity, freedom of choice, achievement of personal goals
That is, using the
The technology/ecology paradigm shifts the focus to the following: lack of fit between the individual with a disability and their environment; lack of access to the appropriate resources that can facilitate that access, including tools, information, and training. The outcomes go beyond those of the previous model and include equal opportunity, freedom of choice, and achievement of their own personal goals. The individual AT user drives the process in partnership with the professional. The photo is of a colleague from Thailand after he transferred from his wheelchair to his car, which he will drive with hand controls that he designed.
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The Technology-Related Assistance Act of 1988 (Tech Act) authorized funding for states to:
- Conduct needs assessments to develop and implement a consumer responsive system of technology-related assistance
- Model delivery systems
- Public awareness programs
- Training & technical assistance
- Reauthorized in 1994, 1998, 2004, 2014
The Assistive Technology Act was first passed by the U.S Congress and signed by the President as the Technology-Related Assistance Act of 1988. It’s often called the Tech Act and has been reauthorized in 1994, 1998, and 2004. The most current version was passed in summer 2014 under the new Workforce Innovation & Opportunity Act.
Detailed history available at: http://www.acl.gov/Programs/CIP/OCASD/AT/history.aspx
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…any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities
- Can be high tech, medium tech, or low tech
AT Devices are defined in the Act as: any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.
These can include low tech to high tech items. Photos include high tech communication device, medium tech scanner/magnifier and reading pens, and low tech reachers.
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…any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device, including:
- Evaluating, purchasing, leasing, selecting, designing, fitting, customizing, repairing, etc.
- Coordinating with other service providers to provide therapy (physical, occupational, speech/language)
- Training, technical assistance
The law defines AT services as follows: …any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device, including:
Evaluating, purchasing, leasing, selecting, designing, fitting, customizing, repairing, etc.
Coordinating with OTs, PTs, other service providers to provide therapy
Training, technical assistance
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- Section 508 of the Rehabilitation Act https://www.section508.gov/
- Americans with Disabilities Act (1990, 2008)http://www.ada.gov
- Individuals with Disabilities Education Act http://idea.ed.gov/
Section 508 of the Rehab Act pertains to all electronic and information technologies developed and used by any Federal government and the need for it to be accessible. This includes websites, video and audio tapes, electronic books, televised programs, and other such media. Individuals with disabilities may still have to use special hardware and/or software to access the resources.
The ADA prohibits discrimination on the basis of disability in employment, state and local government, public accommodations, commercial facilities, transportation, and telecommunications. Four titles (sections) detail requirements in each of these areas.
The Individuals with Disabilities Education Act, which was most recently updated in 2004 addresses AT for school-aged children and describes devices and services that they’re entitled to and how states and public agencies provide these services.
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While public policy calls for for funding & services,
it is our
beliefs & expectations
that drive the implementation to realize valued outcomes.
While public policy calls for funding and services, it is our beliefs and expectations that drive the implementation to realize valued outcomes.
Story of Chris, lost vision, use of legs, partial use of hands due to spinal meningitis. Wanted to become a school counselor – was provided a job folding pizza boxes, due to complying with the letter of the law – get a job that’s good at entry level. What did that do to his confidence, belief in himself?
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- Inclusive, quality education
- Sustainable employment
- Meaningful relationships
- Contributing members of society
If our desired outcomes for IWD are: Inclusive, quality education, Sustainable employment, Meaningful relationships, and being contributing members of society – that is, having a quality life of productivity, health, & well-being, then we need to focus on: ACCESS, OPPORTUNITY, CHOICE
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“Independence is defined in terms of how much control a person has over his or her environment, not in the number of tasks that the person can do without assistance.”
~ Enders & Leech, 1996
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This quote by Enders and Leech provides the context for this presentation - Independence is defined in terms of how much control a person has over his or her environment, not in the number of tasks that the person can do without assistance. Having control over our lives helps to improve the quality of our lives - enhancing health and well-being, relationships, communication, employment, education, recreation and more.
The quote also applies perfectly to David, shown in the photo in the sit ski. He is a high level quadriplegic (C-4 level, paralyzed from the neck down – he can shrug his shoulders and move his head) due to a motorcycle accident over 20 years ago. I met David in a class at SDSU and we became friends. We often present together about the use of AT. Let me tell you a bit about how AT helps David lead a very active life. (For more photos, see https://www.youtube.com/watch?v=_hdLraWFiyU)
Considering any technology:
1. Why did you select it & continue to use it?
2. Why did you give it up?
Think about your smart phone, computer, music equipment, etc. Think of reasons why you got it in the first place. What about things that you don’t use anymore?
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- Individual needs drive process
- Reduces non-use & abandonment of AT
- Focus on “person” vs. “people”
- Need to assess & document outcomes (e.g., AT satisfaction, performance, quality of life)
Scherer, 2002
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David is definitely in charge of the AT process for himself and epitomizes the person-centered or user-centered approach that is the intention of our public policy.
By taking a user-centered approach, we start with the individual’s needs and preferences. Using this approach, the individual driving the process of exploration and problem-solving, which is more likely to result in a good match with the most appropriate technology. Too often, the professional has an idea as to the best technology for someone. But every person is different, even if they have similar disabilities. Further, when the AT user is invested in the process, he will be more apt to use the AT and get the most out of it.
Holly
I met Holly when she called me about applying to our masters degree in Rehabilitation Counseling. She told me about having lost her vision and that she was ready to try something new. This photo was taken with some of our students who just graduated from our distance program when Holly started working with us. More about that shortly.
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Holly & Chris
I’m including this photo of Holly and her neighbor Chris, as Chris was the person who first told Holly about our masters program. They met in the neighborhood after Holly was recovering from cancer and Chris was recovering from a boating accident that left him paralyzed from the shoulders down. In 1991, Holly had gone in for surgery related to the cancer, and after a second surgery, she was placed in an induced coma for 5 days. When she woke up, she was completely blind. At the time she had a 5-year old son and had been working as a social worker. The good news is that she has been cancer-free ever since; she has also remained blind.
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Helping Chris stay fit!
- Interest in home exercise routine
- Researched adaptive equipment
- Holly was convinced that her solution was best
- Chris finally convinced her that it wasn’t what he wanted!
When Holly was in my A.T. class, she chose her friend Chris as her ‘focus individual’ for her project. The goal was to work with an individual who could benefit from A.T. Students are required to do an assessment with that individual and work together to explore possible solutions, either items that are commercially available or that might be modified or customized for that person. Chris wanted a way to exercise at home. Holly found what she thought was the best solution; Chris didn’t see it that way. Holly’s solution was more expensive, more cumbersome, and wasn’t likely to be as easily used. She finally listened to Chris and realized that he had a great and easy idea for a pull-down bar that could be easily installed in his garage. It was a huge lesson for Holly….it’s important to listen to the AT user.
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Re-inventing her life
Back to Holly’s story: Holly tried to go back to work as a social worker but in 1991 the technology just wasn’t there to support her. She couldn’t manage the work, and became frustrated, embarrassed, and depressed. She lost confidence in her abilities and in herself – she no longer felt like the outgoing person she had always been. She was then introduced to the local Center for the Blind where she re-learned basic skills for everyday life – cooking, cleaning, self-care, etc. Then Holly attended classes at the Braille Institute – she started by reading Braille books to her son. Learning Braille as an adult can be quite challenging. Luckily, assistive technology was advancing rapidly and by the time she started regaining her confidence and learned about our graduate program, she didn’t have to depend on reading Braille. Holly’s most used AT is a Braille ‘n Speak, which she uses in combination with her computer. She uses JAWS on her computer so she can hear everything on emails and websites.
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- Explore meanings they assign to devices
- Clarify their expectations of AT
- Consider the anticipated social costs
- Reflect on ways to come to terms with disability as ONE, but not THE defining, feature of oneself.
(Pape, Kim, Weiner, 2002)
Bradley watch:
https://www.eone-time.com
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It’s important to understand how the individual makes meaning of the AT – that is, what does using this AT represent to them individually? For Holly, she had to develop a comfort level with using AT. She found Braille to be too slow and it took her time and practice to learn to use JAWS effectively. When she first started classes in our graduate program, she struggled with using the technology as everything took so much longer. She had to learn to be an auditory learner. As she became more proficient with the technology, her self-image improved. AT users must have a clear idea of what the AT can do for them and what it will take to get there through training and practice. Wearing the BRADLEY watch, given to her by one of the developers she met on a plane: https://www.eone-time.com
In this photo, Holly is showing off her Bradley watch to Chris, as a beautifully designed watch that can be used by individuals with and without vision. Holly always disliked having to hear her watch as it felt disruptive. With the Bradley watch, she can feel the time – and more importantly, it looks cool. She now sees how the AT demonstrates her competence.
Eone was founded to solve this problem. We started with a friendship.
What We Value:
Inclusivity
Accessibility
Aesthetics
Quality
Giving Back
Diversity
Sustainability
A little background on the company. Fascinating what people will come up with to solve problems for friends. Check out their site for the rest of the story.
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Finding a good match:
- With technology
- With a career
- With her new life
After graduating from our program with a masters degree in Rehabilitation Counseling, Holly worked with us in co-teaching some courses and then started working with us in our distance program. One of the benefits of working in our distance program, which is offered 100% online, is that she didn’t have to spend time traveling back and forth to the campus. Taking public transportation from where she lives would take lots of extra time. She now serves as our student advisor in the program, playing a key role in supporting students, faculty, and providing consistency from one course to the next as students complete the 3-year program. She’s especially helpful in encouraging and supporting students who use AT to access the course. She is always checking for accessibility, and works closely with our Center for Distance Learning whenever we’re implementing new software or trying new platforms. She has become an invaluable member of the academic team.
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Part of her neighborhood
Holly had to learn how to use a white cane to increase her independence in navigating her neighborhood and anywhere else she likes to go. She knows all the neighbors, participates in online communities, and in addition to working with us, she is involved in advocacy organizations for supporting safe medical procedures. She has clearly rediscovered her outgoing personality!
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Sebastian
Sebastian is a young man on the autism spectrum. I wanted to include him, as we sometimes only think of individuals with physical disabilities when we consider AT. Sebastian is 18 now and is starting his years of transitioning out of secondary school into his adult life. Sebastian is pictured here in the red shirt during a planning meeting we had with his family, friends, and school personnel. In facilitating a person-driven plan, I was able to help Sebastian and those who know him well, think about his goals and design a plan to help him achieve those.
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Communication
This is a page from Sebastian’s plan, which includes how he best communicates, as he doesn’t speak. He’s very effective at using some sign language, and mostly his own gestures that his mom helps to translate. More important to developing his independence, is his use of an iPad for communication. He uses several programs including Touch Chat and Read & Write Gold to support his learning in school and in exploring ways to connect with others. When we consider AT, we must look at the incentives and disincentives for people to use the devices or equipment. Sebastian has his preferences and his priorities that must be honored. We need to ask, listen, and then respond.
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Not impossible!
- Many dreams
- Many friends
- Good tech skills
- Gaining experience
Sebastian has many interests and everyone came up with creative ideas as to possible directions for his future. He just started classes at one of our local community colleges where he is improving his use of technology and is beginning some work experience as he figures out what he wants to do to earn money. The planning process helped to raise the expectations of what’s possible – and the use of AT will be critical to his success in creating a quality life.
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Finding the right AT match requires:
- understanding the person
- surveying the environment
- assessing the technology
Summarizing the important points: In helping someone to find the right match when using A.T. to connect to a particular activity, it’s critical to consider the person, the environment, and the way that technology fits in for both.
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One of our RC graduates created a “shower foot” with his friend who has one leg amputated. They have a patent and working on a business - AmpuTech.
https://www.youtube.com/watch?v=rySqMiMPygQ
Back to Richard:
One more chance to update your ideas for assistive technology for him:
Before checking out the video of a Day in the Life of Richard, go back to your original list to see if you can add anything else that might be useful for his daily activities. Here’s the link.
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And how about this?
http://www.notimpossiblelabs.com/
Tempt One: The Eyewriter
3D Printing Arms: Project Daniel
